Provider Demographics
NPI:1295915031
Name:CREECH, CONSTANCE J (EDD, APRN, BC, ANP)
Entity type:Individual
Prefix:PROF
First Name:CONSTANCE
Middle Name:J
Last Name:CREECH
Suffix:
Gender:F
Credentials:EDD, APRN, BC, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39595 W 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2948
Mailing Address - Country:US
Mailing Address - Phone:248-476-6980
Mailing Address - Fax:248-474-7462
Practice Address - Street 1:39595 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2948
Practice Address - Country:US
Practice Address - Phone:248-476-6980
Practice Address - Fax:248-474-7462
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704117520363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI12575256OtherCAQH